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Who would benefit from FEES? 

FEES can be performed on any patient with dysphagia. Including patients with dementia, tube feeding, isolation precautions, tracheostomy, ventilator dependent, challenging positioning, and other complex medical needs.

Is FEES new?

FEES is not new. FEES was first implemented in 1986 by Susan Langmore, Ph.D, CCC-SLP, BCS-S, and her research team. Langmore first published data demonstrating the effectiveness of FEES in 1988 (1). 

FEES is within the scope of practice of the Speech-Language Pathologist, and is a highly sensitive and effective instrumental assessment for evaluation of swallowing disorders.


The American Speech-Language Hearing Association (ASHA) endorses the procedure and created guidelines in May of 1991. View ASHA Position Statement (2).


Does it hurt? 

Typically, FEES does not hurt. Topical anesthesia can be used if desired by the patient and when ordered by the physician.


Research by Leder, et al. (1997) noted no significant difference in comfort levels when topical anesthetics or vasoconstrictors were applied, versus a placebo or nothing at all (3).

When is FEES contraindicated? 

FEES is not recommended on patients with bilateral nasal obstructions; facial, maxillary, or nasal fractures; or with history of severe epistaxis (nose bleeds).



What if the patient is unable to sit upright? 

No problem. FEES can be performed in any position the patient is accustomed to eating.



Can FEES be used to detect reflux? 

Evidence of reflux can be observed during FEES because reflux-related changes (redness, swelling, etc.) can be directly visualized during FEES. Reflux can be graded using the Reflux Finding Scale. 

When findings are consistent with esophageal disorders, appropriate referral is made to Gastroenterology. When abnormal laryngeal findings are observed, referral is made to ENT. In this way, FEES can guide the direction of the patient’s clinical management. 


Is FEES safe to perform during COVID-19? 

Yes. Currently, evidence is insufficient to fully determine the risk of aerosol generation during procedures such as FEES. ASHA recommends performing procedures that present a higher infection risk with additional caution and only with use of appropriate PPE recommended by the CDC (4).

The Center for Medicare & Medicaid Services (CMS) revised guidance does not recommend delaying endoscopic procedures (5). Instead, CMS encourages risk assessment with consideration to conserve critical resources (i.e., PPE and ventilators) and limit the risk of exposure of patients and staff to the coronavirus. The Center for Disease Control and Prevention (CDC) has released a similar assessment protocol (6).


As always, we utilize a very strict infection control protocol. Additional steps have been implemented, as recommended by the CDC. Universal precautions, including utilization of PPE, are being used with all patients as indicated by the facility’s infectious disease team.

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